Evolving trends in liver transplantation - An outcome and charge analysis

Background. Due to the limited supply and increased demand for donor livers , waiting times are progressively lengthening, which may lead to transplant ation at more advanced and less cost-effective stages of disease. The purpo se of this study was to evaluate the outcomes and hospital charges of liver transplantation during two recent eras to identify areas for providing mor e cost-effective care. Methods. A total of 144 primary liver allografts were performed from 1991 t o 1996, Patient characteristics, outcome measures, and hospital charges wer e compared for patients receiving allografts between 1991 and 1993 (group A ) versus those receiving grafts between 1994 and 1996 (group B) using unpai red Student t tests for continuous data and chi-squared tests for categoric al data. Results. In comparing groups A and B, no significant differences in patient demographics, relative contraindications, or indication for transplantatio n existed; median waiting time from date of listing until transplant increa sed from 88 days to 159 days; and a shift in UNOS priority status at time o f transplantation occurred, as the percentage of patients requiring inpatie nt care increased from 58% to 75% (P=0.034). Despite this, patient hospital and 1-year survival significantly improved from 75.0% to 90.3% (P=0.016), and from 68.1% to 88.9% (P=0.002), respectively. Total hospital charges, wi thout correction for inflation, were $174,908+/-16,388 in A and $193,525+/- 14,444 in B (P=0.288). The increased charges were associated with longer in patient length of stay (LOS) before transplant, resulting in increased pret ransplant charges from $24,088+/-4134 (A) to $39,490+/-6,196 (B) (P=0.011), Room and service (54%) was the largest pretransplant contributor to charge s, while blood products (23%), room and service (21%), organ acquisition (1 3%), and operating room charges (11%) contributed the most after transplant . Conclusions. Longer waiting times resulting in transplantation at later sta ges of disease have occurred, leading to longer pretransplant LOS and its a ssociated charges. Despite more advanced disease, patient survival rates ha ve significantly improved with fewer infection-related deaths. LOS pretrans plant, blood products, and operating room services represent potential area s for providing more cost-effective care.